International Journal of Trend in Scientific Research and Development (IJTSRD)
Volume 4 Issue 3, April 2020 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470
Place, Personnel & Recollection- Three Modalities on
Antenatal and Newborn Care Messages for Recently
Delivered Women in Uttar Pradesh, India
Dr. Tridibesh Tripathy1, Dr. Uma Kant Prusty2
1Homoeopathic
& Public Health Expert, Master of Public Health
(Community Medicine) Course, Lucknow University, Lucknow, Uttar Pradesh, India
2Research Officer, Regional Institute of Homoeopathy,
Central Council for Research in Homoeopathy, Government of India, Puri, Odisha, India
ABSTRACT
The involvement of CHWs in the state of UP has a long history since the 70s
and currently it is the key strategy to percolate primary health care to the
masses through the Front-Line Workers like the Accredited Social Health
Activists (ASHA) and the Angan Wadi Workers (AWW). Besides the AWWs,
the current lot of CHWs in UP are the ASHAs who are the daughters-in-law
of a family that resides in the same community that they serve as the
grassroots health worker since 2005 when the NRHM was introduced in
the EAG states. UP is one such Empowered Action Group (EAG) state. The
current study explores three crucial variables of the messages Ante Natal
Care (ANC), birth preparedness and newborn care. These three variables
are reflected through the role of health personnel through messages in
these components provided to the Recently Delivered Women (RDW) or
mothers in four districts of UP. From the catchment area of each ASHA, two
RDWs were selected who had a child in the age group of 3 to 6 months.
Through this profile, the messages on ANC, birth preparedness and
newborn care dealt in a triad of modalities consisting of the place,
personnel and recollection of these messages. The message profiles of the
RDWs on these stages are reflected upon to give a picture that represents
the entire state of UP.
The results showed that almost all the
RDWs in the four districts had received
the ante natal care messages at home and
by the ASHAs. Gonda district fell behind in
recollection of ANC messages among the
four districts. Regarding newborn care
messages, again Gonda district faltered
among the four districts. The newborn
care message had a gender issue related
message which asked whether the RDW
received a message to care of the unborn
boy or girl equally. Gonda district
performed poorly in this indicator as well.
The relevance of the study assumes significance as data on the modalities
of messages for ANCs, birth preparedness and newborn care for recently
delivered mothers are not available even in large scale surveys like
National Family Health Survey 4 done in 2015-16. The percentage of
women covered for the four ANCs along with coverage of broad areas are
given not exclusively but clubbed together. The three modalities like place,
recollection and type of health worker who gave the message. The current
study gives an insight in to these three modalities exclusively for the
messages separately. The current study is basically regarding the message
profiles of RDWs during their pregnancies.
KEYWORDS: RDW, ASHA, NRHM, EAG, CHW,
ANC, Newborn
Regarding the messages on birth
preparedness, Saharanpur led the list and
Gonda district again lagged behind. This
meant that the ASHAs of Gonda district
are poor planners among the four
districts.
How to cite this paper: Dr. Tridibesh
Tripathy | Dr. Uma Kant Prusty "Place,
Personnel & Recollection- Three Modalities
on Antenatal and Newborn Care Messages
for Recently Delivered Women in Uttar
Pradesh,
India"
Published
in
International Journal of
Trend in Scientific
Research
and
Development (ijtsrd),
ISSN:
2456-6470,
IJTSRD30774
Volume-4 | Issue-3,
April
2020,
pp.957-966,
URL:
www.ijtsrd.com/papers/ijtsrd30774.pdf
The above-mentioned reasons regarding dissemination of messages
reflects poorly in the Infant Mortality Rates (IMR) and Maternal Mortality
Ratios (MMR) in India and especially in UP. The current IMR in India is 33
where as it is 41 in UP which means 8 points higher per 1000 live births
(SRS, May 2019). Similarly, the current MMR in India is 122 where as it is
216 in UP which really reflects poorly for UP in comparison to the data at
national level (SRS, November, 2019). These mortalities are the impact
indicators and such indicators can be reduced through long drawn a
process that includes effective delivery of messages to RDWs during their
pregnancies. This is the area that the current study details out.
Copyright © 2020 by author(s) and
International Journal of Trend in Scientific
Research and Development Journal. This is
an Open Access article
distributed under the
terms of the Creative
Commons Attribution License (CC BY 4.0)
(http://creativecommons.org/licenses/by/
4.0)
A total of four districts of Uttar Pradesh were selected purposively for the
study and the data collection was conducted in the villages of the
respective districts with the help of a pre-tested structured interview
schedule with both close-ended and open-ended questions. In addition, indepth interviews were also conducted amongst the RDWs and a total 500
respondents had participated in the study.
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INTRODUCTION
As RDWs were selected from the catchment area of the
ASHAs in the four districts, the following section briefs out
the details on ASHAs.
The ASHAs were recruited by the Local Self Governance from
their own communities as per the guidelines set by NHM.
Subsequent to the roll out of guidelines at the central level,
the state of UP also rolled out the recruitment of ASHAs
through the setting up of State Program Management Unit of
NHM at state level and the District Program Management
Unit (DPMU) at district level. These DPMUs helped set up the
Block Program Management Unit at the block level. These
units got in touch with the Panchayati Raj Institutions which
was part of LSGs and these PRIs represented by the Gram
Pradhans or the village panchayat head nominated the
ASHAs from the respective communities. They attached the
ASHAs with the public health system at the block level to
work as ASHAs who are incentive based workers. (GOUP,
PIP, NHM, 2008).
Like India, UP also went through the CHW scheme in 1970s
through the introduction of Village Health Guide in 1977 (5th
Plan GOI, 1974-79) and the concept was ratified further in
the Alma Ata conference of 1978 on primary health care. On
the other hand, with the introduction of Integrated Child
Development Services in 1975 (5th Plan GOI, 1974-79) the
Angan Wadi Workers were in place as CHWs in phases.
Simultaneously, local Traditional Birth Attendants were in
place since 1977 as CHWs (5th plan, GOI, 1974-79).
Thereafter, the multipurpose male and female health
workers came in to place through the Child survival and Safe
Motherhood program in 1992 (Yearly Plan, GOI, 1992).
Besides the sporadic efforts of NGOs putting in place CHWs
through their small efforts in definite geographic areas, the
cadre of Basic Health Workers were put in by the health
system from 1992 till 2005 (GOI, 2005). Gradually the CHWs
came here to stay with the introduction of ASHAs in 2005
through the introduction of NRHM (GOI, 2005). As per GOUP,
there were 1,50,000 ASHAs in UP in 2019. The selection of
RDWs in this study is dependent on the ASHAs.
Studies on RDWs in UP have not covered on aspects like
place, personnel and recollection of ANC, birth preparedness
and newborn care messages through health visits and details
of the components of these stages covered during these
visits. The current study reflects on these aspects in detail
including the recollection of messages given by the health
workers to the RDWs.
ANC, Birth preparedness & Newborn care messages for
RDWs during pregnancy in UP
The ASHAs emerged in India’s public health system during
the launch of NRHM in 2005 in the state of Uttar Pradesh
(GOI, 2005). The ASHAs were in fact inducted to NRHM with
the primary aim to roll out the JSY component of NRHM (GOI,
2005).
A study done in UP regarding the performance of ASHA
mentions that 96% of ASHAs mobilized the community for
ANC. The mention of messages on birth preparedness and
newborn care needed further analysis. Further, the analysis
of the individual components of messages on ANC mentions
that all the pregnant women registered in UP were mobilized
on birth preparedness and newborn care but the data is
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embedded in ANC mobilization. It also mentions that 98%
mobilized on exclusive breast feeding and complementary
feeding, 99% on infant immunization, 93% on family
planning and 98% on health, hygiene and nutrition (Bajpai
N, Dholakia R, 2011). It is significant to note that here the
providers were the source of information unlike the
receivers that are mentioned in the study.
The project close-out report of Vistaar project of United
States Agency for International Development (USAID) that
was operational in the state of UP from 2006-2012 stresses
that nutrition and anemia related knowledge among
pregnant women and recently delivered women improved. It
also mentions that the project implementation increased the
reach of nutritional counselling to the recently delivered
women. The report also mentions increased receipt and
consumption levels of iron and folic acid tablets. The report
mentions achievements qualitatively unlike the current
study that quantifies the data (EOP report, Vistaar project,
2013).
Another evaluation study of ASHA scheme in UP states that
ANC is a support service. Regarding awareness, the study
mentions awareness generation is one of the components of
the support service combined with other services. Birth
preparedness and escort services constitute 6.8% as told by
the eligible women. There is no mention about the place and
recollection of these messages by the women. Regarding
motivation, 95.3% of eligible women were motivated by the
ASHAs while 44.21% of eligible women reported that they
have received support three times by the ASHAs
(GOUP,2013). Here again, we can see the clubbing of
information under messages on ANC and not exclusively as
done in the current study.
The National Family Health Survey report written in 2017
for UP states that 24% of mothers in UP did not receive any
ANC. On the message aspect, the report states that among
the women with a live birth in the five years preceding the
survey who met with a community health worker in the last
three months of pregnancy for their most recent live birth,
the advices were better percolated. The report details that at
least two-fifths of these women received advice on five
different areas in UP. Here, 63% of these two-fifths received
on importance of institutional delivery, 56% on breast
feeding, 48% on cord care, 47% on keeping the baby warm
and 43% on family planning. The ANC coverage for the
selected districts of the current study shows that in
Saharanpur district 42% of mothers received at least 4 ANC
visits followed by Barabanki at 24% coverage. Gonda district
with 14% and Banda district at 6.4% coverage were poorly
covered (NFHS 4, 2015-16).
Besides the content of messages, ways to disseminate the
messages are also crucial. The importance of short
messaging is reinforced in a study that mentions “a short
messaging service targeting pregnant women is an
invaluable and affordable intervention to improve maternal
health care seeking behaviors (Wagnew F, et.al, 2018). In the
current study, the method to percolate the message is
through use of IEC materials by the health workers.
Surprisingly, unlike other indicators, Gonda district leads
among the four districts where 41% of AWWs used picture
book to deliver the messages.
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To percolate messages, contacts among RDWs and health
personnel either at home or outreach points are crucial. This
aspect is mentioned in another study in UP. It was revealed
that contacts with health worker during pregnancy,
marginalization, at least three ANC visits & institutional
delivery were the strong determinants for utilization of Post
Natal Services (Singh, R, et.al, 2019). In the current study,
most of the RDWs replied through recollection that they
have received these messages at home.
The current study done in 2017 examines the profile of
RDWs in the catchment area of ASHAs regarding ANC, birth
preparedness and newborn care messages during any
contact with health personnel. The study also delves into the
place where the messages were given and who gave the
message and whether the RDWs could recollect the given
message to them.
Research Methodology
Using purposive sampling technique, four districts were
chosen from the four different economic regions of UP,
namely Central, Eastern, Western and Bundelkhand. Further,
the Government of UP in 2009 categorized the districts as
per their development status using a composition of 36
indicators. Purposefully, the high developed district chosen
for the study is Saharanpur from the western region, the
medium developed district chosen for the study is Barabanki
from the central region, the low developed district chosen
for the study is Gonda from the eastern region and the very
low developed district chosen for the study is Banda from
the Bundelkhand region (GOUP, 2009).
In the next step, purposefully two blocks were selected from
each of the district and all the ASHAs in these blocks were
chosen as the universe for the study. From the list of all the
ASHAs in each of the two blocks, 31 ASHAs were chosen
randomly from each block for the study. In this way, 62
ASHAs were chosen for the study from each of the districts.
In Gonda district, 64 ASHAs were selected to make the total
number of ASHAs for the study to 250. From the catchment
area of each ASHA, two Recently Delivered Women (RDW)
were chosen who had a child in the age group of 3-6 months
during the time of the data collection for the study. In this
way, 124 RDWs from three districts and 128 RDWs from
Gonda district were chosen thus a total of 500 RDWs were
selected for the study.
The following figure shows the four districts of UP in the
map of the state of UP.
Figure 1
The data was analyzed using SPSS software to calculate the
percentage and absolute values of RDWs using the detail
profiles of the ANC, birth preparedness and newborn care as
per the data in the four study districts. The quantitative data
related to the profiles was seen for RDWs that forms the
basis of the ensuing results and discussion.
Research tools
The RDWs were interviewed using an in-depth, open-ended
interview schedule which included a section on various
components of ANC, newborn care and birth preparedness.
Under the services of ASHAs section of the tool, the RDWs
were asked on their ANC, birth preparedness and newborn
care messages. They were asked whether they were aware
or whether any one told them about ante natal, birth
preparedness and newborn care. They were asked about
each message and replies were collected if they replied
spontaneously or after prompting. There were 7 messages
on antenatal care, 5 on birth preparedness and 10 on
newborn care. Next, they were asked if ASHA, AWW,
ANM/LHV told them these messages or if they knew already.
Information was also collected if anyone else told them the
message other than the above-mentioned four personnel.
Regarding place, it was elicited if they received the messages
at home, VHND sessions or anywhere else. All these
questions/messages were under one descriptive question
that had multiple exclusive and exhaustive variables. In this
way, 500 research tools were used for the study to interview
500 recently delivered women who had a child in the age
group of 3 to 6 months during the survey. The following
section details out the results and discussions related to the
study.
Results and discussions
As mentioned above, there are messages on antenatal care, newborn care and birth preparedness and therefore there are 24
tables in this section. 19 tables on messages, 4 tables on descriptive and analytical statistics on the data related to these
messages and one table on the use of IEC materials by the health workers to give these messages. Besides these, there are two
figures in the study where the first one shows the districts through an outline map of UP and the second regarding the
descriptive analysis through a graph showing the mean level of awareness on these messages.
Table 1
Consumption of 100 IFA tablets/3 bottles of syrup
Names of districts & number of
RDWs surveyed
Percentage of RDWs who could
recollect the message
Percentage of RDWs who
received this message from ASHA
Percentage of RDWs who
received this message at home
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Banda (n=124)
Barabanki (n=124)
Gonda (n=128)
Saharanpur
(n=124)
99
93.6
74.7
100
99.2
85.5
75
100
99.2
82.3
68.8
100
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Similarly, Gonda district again faltered for the message on consumption of 100 IFA tablets or three bottles of syrup. In Gonda.
the percentage for recollect, from ASHA and at home for this message stood at 75, 75 and 69 respectively. It was more than
82% in rest of the three districts.
Names of districts & number of
RDWs surveyed (n=500)
Percentage of RDWs who could
recollect the message
Percentage of RDWs who received
this message from ASHA
Percentage of RDWs who received
this message at home
Table 2
Side effects of taking IFA tablets
Banda
Barabanki
(n=124)
(n=124)
Gonda
(n=128)
Saharanpur
(n=124)
81.1
46
80.2
63.2
82.3
35.5
64.8
66.9
79
32.3
62.5
66.9
Following this message was the message on side effects of taking these tablets. Only 43% in Barabanki and 63% in Saharanpur
could recollect this message where as it was more than 80% in the other two districts. Only 35%, 65% and 67% of RDWs
received this message from ASHAs in Barabanki, Gonda and Saharanpur respectively but 82% of RDWs received the message
from ASHA in Banda.
At home, this message was received by 32% in Barabanki, 62% in Gonda and 67% in Saharanpur. The percentage for Banda
was 79% for this aspect of the message.
Table 3
Consumption of nutritious foods during pregnancy
Names of districts & number of
Banda
Barabanki
Gonda
RDWs surveyed (n=500)
(n=124)
(n=124)
(n=128)
Percentage of RDWs who could
93.4
92.6
83.2
recollect the message
Percentage of RDWs who received
96.8
83.1
75
this message from ASHA
Percentage of RDWs who received
96.8
79.8
70.3
this message at home
Saharanpur
(n=124)
100
100
100
The message for consumption of nutritious foods during pregnancy was recollected by 83% of RDWs in Gonda and more than
93% of RDWs in the other three districts. 75% in Gonda and 83% in Barabanki received the message from ASHA whereas
almost all the RDWs received from ASHA in the other two districts.
At home, 70% in Gonda and 80% in Barabanki received the message and in the other two districts, almost all the RDWs
received the message at home.
Table 4
Rest for 2 hours in a day
Names of districts & number of
Banda
Barabanki
Gonda
Saharanpur
RDWs surveyed (n=500)
(n=124)
(n=124)
(n=128)
(n=124)
Percentage of RDWs who could
95.4
93.4
89.3
98.3
recollect the message
Percentage of RDWs who
96
83.9
78.1
99.2
received this message from ASHA
Percentage of RDWs who
96
79.8
75
98.4
received this message at home
More than 75% of RDWs in all the 4 districts replied that the message for rest for 2 hours in a day was recollected, was received
from ASHA and received at home.
Table 5
Percentage of RDWs who were aware or received messages about birth preparedness during their pregnancy
by health personnel during their pregnancy
Identification of place of delivery (hospital/home)
Names of districts & number of
Banda
Barabanki
Gonda
Saharanpur
RDWs surveyed (n=500)
(n=124)
(n=124)
(n=128)
(n=124)
Percentage of RDWs who could
96.4
94.3
95
99.1
recollect the message
Percentage of RDWs who
96.8
84.7
85.2
99.2
received this message from ASHA
Percentage of RDWs who
96
79.8
81.3
98.4
received this message at home
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Next was regarding the messages on birth preparedness. The message on identification of a place of delivery- hospital/home
was recollected, received from ASHA and received at home by more than 81% across the 4 districts with Saharanpur leading
the list with almost all the RDWs in all the three aspects of the message.
Names of districts & number of
RDWs surveyed (n=500)
Percentage of RDWs who could
recollect the message
Percentage of RDWs who received
this message from ASHA
Percentage of RDWs who received
this message at home
Table 6
Informed about JSY
Banda
Barabanki
(n=124)
(n=124)
Gonda
(n=128)
Saharanpur
(n=124)
96.7
100
94.8
100
96.8
91.1
85.9
100
96.8
86.3
83.6
99.2
The data regarding information on JSY in the 4 districts showed that in all the three aspects of the message we had more than
85% of RDWs replying on the three aspects. Only in Gonda, 84% of RDWs replied that they received the message at home.
Table 7
Saving or arranging money for delivery
Names of districts & number of
Banda
Barabanki
RDWs surveyed (n=500)
(n=124)
(n=124)
Percentage of RDWs who could
97.7
100
recollect the message
Percentage of RDWs who received
96.8
91.1
this message from ASHA
Percentage of RDWs who received
96.8
86.3
this message at home
Gonda
(n=128)
Saharanpur
(n=124)
94.9
100
89.8
100
84.4
99.2
Similar was the case for the message on saving or arranging money for delivery where 84% of RDWs in Gonda replied that they
received the message at home. In rest of the 3 districts, more than 85% of RDWs replied on the three aspects of the message.
Names of districts & number of RDWs
surveyed (n=500)
Percentage of RDWs who could
recollect the message
Percentage of RDWs who received this
message from ASHA
Percentage of RDWs who received this
message at home
Table 8
Using DDK for home delivery
Banda
Barabanki
(n=124)
(n=124)
Gonda
(n=128)
Saharanpur
(n=124)
96.5
100
93.5
98.3
96.8
91.1
86.7
98.4
96.8
86.3
83.6
97.6
For the message on using DDK for home delivery, we saw that the minimum percentage was for Gonda among the 4 districts. In
Gonda, 87% of RDWs received the message but 84% received the message at home.
Table 9
Arranging mode of transport to travel to institution
Names of districts & number of RDWs
Banda
Barabanki
Gonda
surveyed (n=500)
(n=124)
(n=124)
(n=128)
Percentage of RDWs who could
96
100
91.4
recollect the message
Percentage of RDWs who received this
96.8
91.1
82.8
message from ASHA
Percentage of RDWs who received this
96.8
87.1
79.7
message at home
Saharanpur
(n=124)
99.1
99.2
98.4
Gonda again lagged behind among the 4 districts in dissemination of message on arranging mode of transport to travel to
institution. In all the three aspects of the message, the other 3 districts had more than 87% of RDWs replying on the three
aspects of the message but Gonda had 83% of RDWs receiving the message from ASHA and 80% of RDWs receiving the
message at home.
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Table 10
Percentage of RDWs who were aware or received various types of newborn care messages during their
pregnancy from health personnel
Initiate breastfeeding within an hour of birth
Names of districts & number of
Banda
Barabanki
Gonda
Saharanpur
RDWs surveyed (n=500)
(n=124)
(n=124)
(n=128)
(n=124)
Percentage of RDWs who could
95.9
95.9
82.1
99.1
recollect the message
Percentage of RDWs who received
96.8
87.1
78.9
99.2
this message from ASHA
Percentage of RDWs who received
96.8
83.9
75
98.4
this message at home
The next aspect was the newborn care messages which the RDWs knew or received from health personnel during their
pregnancy. More than 84% of RDWs replied on the three aspects of the message on initiating breastfeeding within an hour of
birth in 3 districts except Gonda where 82% of RDWs could recollect the message, 79% received the message from ASHA and
75% of RDWs received the message at home.
Table 11
Benefits of colostrum feeding (figures in percentages)
Banda
Barabanki
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
RDWs who could recollect the message
95.9
99.1
RDWs who received this message from ASHA
96.8
91.1
RDWs who received this message at home
96.8
87.9
Gonda
(n=128)
97.7
93.8
88.3
Saharanpur
(n=124)
98.9
99.2
99.2
About 88% of RDWs in Barabanki and Gonda districts received the message on benefits of colostrum feeding at home and in all
the three aspects of this message more than 88% of RDWs replied in the 4 districts.
Table 12
Feed only breast milk to the newborn up to 6 months (figures in percentage)
Banda
Barabanki
Gonda
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
(n=128)
RDWs who could recollect this message
95.8
98.1
83
RDWs who received this message from ASHA
96.8
88.7
86.7
RDWs who received this message at home
96.8
86.3
83.6
Saharanpur
(n=124)
97.7
98.4
98.4
In Gonda, 83% of RDWs could recollect and 84% received the message at home about feeding only breast milk to the newborn
up to 6 months. In the rest of the aspects of the message in the 4 districts more than 87% of RDWs replied on this message.
Table 13
Do not apply anything on the cord
Banda
Barabanki
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
Percentage of RDWs who could recollect this message
95.9
98.2
Percentage of RDWs who received this message from
96.8
88.7
ASHA
Percentage of RDWs who received this message at home
96.8
88.7
Gonda
(n=128)
79.8
Saharanpur
(n=124)
98.8
82.8
99.2
80.5
99.2
The message on not to apply anything on the cord was recollected by 80% of RDWs, 83% received from ASHA and 81%
received at home in Gonda district but in all the aspects of the message in the 4 districts more than 89% of RDWs replied
regarding the message.
Table 14
Dry and wrap the newborn immediately after birth
Banda
Barabanki
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
Percentage of RDWs who could recollect this message
96.1
100
Percentage of RDWs who received this message from
96.8
84.7
ASHA
Percentage of RDWs who received this message at home
96.8
84.7
Gonda
(n=128)
84
Saharanpur
(n=124)
95.3
78.9
96
78.1
96
Regarding the message on drying and wrapping the newborn immediately after birth, in Gonda 79% received the message from
ASHA and 78% at home. It was more than 84% in all the aspects of the message in the four districts.
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Table 15
Continue to keep the newborn warm
Banda
Barabanki
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
Percentage of RDWs who could recollect this message
96.1
100
Percentage of RDWs who received this message from ASHA
96.8
85.5
Percentage of RDWs who received this message at home
96.8
84.7
Gonda
(n=128)
84.3
81.3
78.9
Saharanpur
(n=124)
98.8
98.4
98.4
The next message on the warmth component was to continue to keep the newborn warm. Here Gonda district showed that 81%
of RDWs received the message from ASHA and 79% at home. In all the rest aspects of the message at least 85% or more than
85% of RDWs replied on this message across the 4 districts.
Table 16
Do not bathe the newborn till 7 days (figures in percentage)
Banda
Barabanki
Gonda
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
(n=128)
RDWs who could recollect this message
96.1
100
87.5
RDWs who received this message from ASHA
96.8
86.3
81.3
RDWs who received this message at home
96.8
86.3
80.5
Saharanpur
(n=124)
98.8
99.2
99.2
At least 81% and more than 81% of RDWs in the 4 districts replied on the three aspects of the message on not to bathe the
newborn till 7 days. Gonda was the district with the minimum percentage for this message also.
Table 17
Weighing the newborn (figures in percentage)
Banda
Barabanki
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
RDWs who could recollect this message
95.3
100
RDWs who received this message from ASHA
96
88.7
RDWs who received this message at home
96
88.7
Gonda
(n=128)
84
73.4
71.1
Saharanpur
(n=124)
98.9
99.2
99.2
The message of weighing the newborn was received by 73% of RDWs by ASHA and 71% of RDWs received at home in Gonda
district. The other aspect of the same message was replied by more than 84% of RDWs in the 4 districts.
Table 18
Getting the newborn immunized
Banda
Barabanki
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
Percentage of RDWs who could recollect this message
95.3
100
Percentage of RDWs who received this message from ASHA
96
78.2
Percentage of RDWs who received this message at home
96
73.4
Gonda
(n=128)
94.7
71.9
69.5
Saharanpur
(n=124)
94.3
81.5
83.1
About 95% of RDWs in the 4 districts could recollect the message on getting the newborn immunized. 72% received the
message from ASHA in Gonda, 78% in Barabanki and 82% in Saharanpur and 96% of RDWs in Banda. Only 70% of RDWs in
Gonda, 73% in Barabanki and 83% of RDWs in Saharanpur received this message at home while it is 96% in Banda district.
Table 19
Caring equally for boy or girl (figures in percentages)
Banda
Barabanki
Names of districts & number of RDWs surveyed (n=500)
(n=124)
(n=124)
RDWs who could recollect this message
96.3
100
RDWs who received this message from ASHA
96.8
87.9
RDWs who received this message at home
96.8
88.7
Gonda
(n=128)
96.6
74.2
80.5
Saharanpur
(n=124)
98.9
98.4
96.8
The message on caring equally for a boy/girl addressing gender equality was recollected by more than 96% of RDWs in all the 4
districts. 74% in Gonda and 88% in Barabanki received this message from ASHA but more than 96% of RDWs in the rest 2
districts. 81% in Gonda and 89% in Barabanki received the message at home where as it was more than 96% in the other 2
districts.
The table below gave the descriptive statistics such as mean, standard deviation, standard error, minimum and maximum
values as per tables 10 to 19.
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Districts
N
Mean
Banda
Barabanki
124
124
21.0887
21.1048
Standard
deviation
3.66041
1.29300
Gonda
Saharanpur
Total
128
124
500
20.3516
21.4194
20.9860
4.51348
1.31345
3.07909
Table 19.1.0
Standard
Mean (lower
Error
bound) at 95% CI
0.32871
20.4380
0.11611
20.8750
0.39894
0.11795
0.13770
Mean (upper bound)
at 95% CI
21.7394
21.3347
19.5621
21.1859
20.7155
21.1410
21.6528
21.2565
The table below gave the minimum and maximum value for the variables on awareness level from table 10 to 19.
Table 19.1.1
Districts
Minimum value Maximum value
Banda
Barabanki
Gonda
Saharnpur
Total
0.00
16.00
0.00
11.00
0.00
23.00
23.00
23.00
23.00
23.00
The table below gave the Analysis of Variance (ANOVA) values for the variables from table 10 to 19. A one-way ANOVA was
conducted to determine the awareness level of RDWs among between groups of RDWs in the four districts and within groups of
RDWs in each of the district. The difference between the groups of RDWs in the four districts was statistically significant, F (3,
496) = 2.767, P < 0.05.
Table 19.1.2 ANOVA
Sum of Squares Df Mean Square
Between Groups
Within Groups
Total
77.867
4653.035
4730.902
3
496
499
25.956
9.381
F
Sig.
2.767 .041
The table below gave the descriptive statistics like mean difference, standard error, significance, lower and upper values for the
variables from table 10 to 19.
Table 19.1.3
(I) QA_D
(J) QA_D
1 Banda
2 Barabanki
3 Gonda
4 Saharanpur
1 Banda
2 Barabanki
3 Gonda
4 Saharanpur
1 Banda
3 Gonda
2 Barabanki
4 Saharanpur
-.01613
.73715
-.33065
.38898
.38593
.38898
95% Confidence Interval
Lower Bound Upper Bound
1.000
-1.0465
1.0142
.340
-.2851
1.7594
1.000
-1.3610
.6997
.01613
.75328
-.31452
-.73715
-.75328
-1.06779*
.38898
.38593
.38898
.38593
.38593
.38593
1.000
.309
1.000
.340
.309
.035
-1.0142
-.2690
-1.3449
-1.7594
-1.7756
-2.0901
1.0465
1.7756
.7159
.2851
.2690
-.0455
.38898
.38898
.38593
1.000
1.000
.035
-.6997
-.7159
.0455
1.3610
1.3449
2.0901
Mean Difference (I-J) Std. Error
1 Banda
.33065
4 Saharanpur 2 Barabanki
.31452
3 Gonda
1.06779*
*. The mean difference is significant at the 0.05 level.
Sig.
The figure below showed the graph of the mean of the variables from table 19.1. It showed that Gonda district had the lowest
mean among the four districts. As it dealt with question number 309 of the research tool where the messages were subsets of
the said question, the figure mentions mean of q309 from option A to W.
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Figure 2
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Table 20
Percentage of RDWs with whom ASHA/AWW used any picture book to deliver the above-mentioned newborn
care messages
Names of districts & number of
Banda
Barabanki
Gonda
Saharanpur
RDWs surveyed (n=500)
(n=124)
(n=124)
(n=128)
(n=124)
ASHA has used
0.0
0.8
10
16
AWW has used
0.0
0.0
41.4
0.0
The messages were best delivered when IEC was used to disseminate the messages. Here we found that only 16%, 10% and 1%
of ASHAs in Saharanpur, Gonda and Barabanki used the IEC material respectively. In Banda, the RDWs replied that none of the
ASHAs used the materials. Besides ASHA, the RDWs replied that 41% of AWWs used IEC material in Gonda and none of the
AWWs used it in the rest of the 3 districts.
Conclusions
The above results showed that the profile of the messages on
ANC, birth preparedness and newborn care services of
RDWs vary a lot across the districts. The process of
percolating the message is also done poorly as shown
through the data of use of IEC materials in this study. The
dissemination process either at home or at an outreach
center should also focus on involving all the stake holders.
The messages on ANC, birth preparedness and newborn care
services of RDWs should represent not only three modalities
as mentioned in this study but also all the various modalities
optimally so that the heterogenicity of messages regarding
these cares are better accepted and understood by the
communities. This will help RDWs to be in focus so that
maternal health also get priority. Data should be collected in
large scale surveys on these parameters of ANC, birth
preparedness and newborn care services of RDWs
exclusively as they can give crucial information regarding
maternal health. The inclusion of role of not only ASHA but
any type of health personnel regarding messages on these
three services will help in designing better outreach services
regarding maternal health. All these efforts would lead to
reduction in the level of impact indicators mentioned above
for maternal & child health through MMR, IMR in UP & as a
result in India as well.
References
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performance of ASHAs in India, working paper No.1,
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[2] GOI (2005, 2015) Ministry of Health and Family
Welfare; Update on the ASHA Programme, April 2005,
January 2015.
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[3] Government of Uttar Pradesh (2009). Planning Atlas of
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[4] National Family Health Survey, India, Uttar Pradesh,
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[8] GOUP, PIP, NHM, 2019.
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[13] SRS, Special bulletin on maternal mortality in India,
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